Hawaii (2019- )

The Our Care, Our Choice Act requires an annual report to be issued, however, there is no requirement under the Act for any information to be reported to the Department of Health on the reasons for requesting assisted suicide (apart from the underlying condition), on complications, on the length of the patient-doctor relationship, on the length of time from first request to death or from ingestion to either unconsciousness or death. There is no requirement for any witness to the lethal act.

Assisted suicide by telehealth

The Act requires the “attending provider” to refer every person who requests assisted suicide for “counselling” which is defined as “one or more consultations, which may be provided through telehealth, as necessary between a psychiatrist, psychologist or clinical social worker and a patient for the purpose of determining that the patient is capable, and that the patient does not appear to be suffering from undertreatment or nontreatment of depression or other conditions which may interfere with the patient's ability to make an informed decision pursuant to this chapter."

The use of telehealth for this purpose has been criticised by Katherine Drabiak, an assistant professor in the College of Public Health at the University of Southern Florida. She writes:

“Understanding the patient’s psychological condition is important because research in Oregon has found that patients considering PAS [physician assisted suicide] have concerns relating to loss of autonomy, ability to engage in activities that make life enjoyable, and loss of dignity. (Contrary to popular belief, excruciating pain is not a substantial factor in patient decisions to seek PAS.) Under Hawaii’s law, however, a patient may obtain a consultation via telehealth. While telehealth promises to reduce cost and increase efficiency to address other health care issues, we should pause to consider the sufficiency and ethics of a remote consultation with patients to discuss their motivations and screen for potential problems.

I take issue with what I see as a pro forma requirement. It looks like a protection, but it’s not designed to address underlying issues such as a patient’s depression and whether it could be relieved. Patients facing psychological, social, or existential concerns deserve compassion in the form of reassurance, social support, and practical solutions to address feeling like a burden on others. Needing connection and validation throughout our life–and especially at our most vulnerable when we require assistance from others–translates to knowing that we are meaningful and loved.”

Minimal data

The Act requires an annual report to be issued, however, there is no requirement under the Act for any information to be reported to the Department of Health on the reasons for requesting assisted suicide (apart from the underlying condition), on complications, on the length of the patient-doctor relationship, on the length of time from first request to death or from ingestion to either unconsciousness or death. There is no requirement for any witness to the lethal act.

Forcing participation - No assisted suicide free zones allowed

Although the Act contains explicit provisions protecting the right of a health care facility to prevent health care providers in its employ or on its premises from “participating” in the provision of assisted suicide there may be gaps in this provisions.

The American Civil Liberties Union is already threatening a law suit against Kahala Nui, a continuing care retirement community, which is run by a non-profit organisation and is situated on land owned by the Catholic Church, to force it to repeal a provision in its residents agreement which makes it clear that acts of assisted suicide under Hawaii’s new law are not permitted in the community.

The proponents of assisted suicide bitterly and aggressively object to any organisation seeking to preserve a life-affirming ethos.

Conclusion

As Hawaii's experiment with assisted suicide begins it is clear that the lack of data will prevent proper scrutiny. The novel use of telehealth in assessing competence to request assisted suicide is disturbing.

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